Getting Started in Private Practice

The Complete Guide to Building Your Mental Health Practice

Chris E. Stout, Laurie C. Grand

• Publisher: Wiley
• Year: 2010
• Print ISBN: 9780471426233
• eBook ISBN: 9780470893494
• Edition: 1
• Topic: Psychology
• Subtopic: Research & Methodology in Psychology
• Index: Psychology

All the tips and tools you need to build a successful mental health practice from the ground up Many mental health professionals currently working for group practices, hospitals, and private or government agencies have both the skills and the drive to become solo practitioners. But how and where do you begin? Getting Started in Private Practice is a reliable reference that offers the comprehensive information and armchair motivation you need to establish and build your own practice from the ground up. User-friendly and full of helpful tips, this handy book provides you with tools and techniques for starting and maintaining a thriving private practice, including information on:
* Discovering your ideal practice
* Creating a business plan
* Financing your start-up
* Setting fees
* Setting up shop and measuring results
* Minimizing risk
* Managing managed care
* Marketing your practice
* Generating referrals
* Utilizing additional print, Web, and organizational resources
From major concerns such as ethics and liability to day-to-day matters like selecting stationery and business cards, Getting Started in Private Practice puts the best solutions at your fingertips. Whether you're a recent graduate or a seasoned pro, this invaluable resource will help you minimize the uncertainty of establishing a solo practice while maximizing the rewards.

CHAPTER 1

Discover Your Ideal Practice

PRACTICE BY DESIGN: GO SOLO OR JOIN A GROUP?

Today’s behavioral healthcare marketplace has created new challenges for mental health professionals in every type of practice setting. In the past, therapists with offices in one or two locations could make an adequate living and enjoy the benefits of working independently. Today, however, it is difficult to thrive or even survive in independent practice, especially in areas where managed care has become a major force. There are new challenges for every type of practice, including medium and large groups.

There are a variety of models for you to consider when you prepare to set out on your own. Let’s begin by looking at the most common types of private practices.

INDEPENDENT SOLO PRACTICE

In this type of practice, the therapist works on his or her own. This means that you:

• Rent and furnish your own office space

• Work mostly on your own

• Do your own marketing

• Decide on the fee structure

• Find your own clients

• Do your own treatment

• Find your own supervision

• Get on managed care panels and lists

• Pay the cost of association memberships, subscriptions, publications, and so forth

• Pay the cost of continuing education units

• Pay for your own health and life insurance

• Design your own forms, stationery, handouts, and so on

• Pay all of the expenses associated with the practice

• Process the insurance reimbursement paperwork

In the past, solo practitioners answered only to themselves (while following the legal and ethical guidelines of the profession). Today, with the advent of managed care, solo practitioners may work alone but must fulfill the requirements of managed care organizations in order to obtain reimbursement for their services.

STATE LICENSING REQUIREMENTS

Most states and provinces require clinicians to be licensed in order to practice. This was not always the case, and many people are still practicing illegally by providing therapy services without a license. Other states have laws that regulate the terms of use of specific words (psychotherapy, psychology, etc.) rather than the practice of these disciplines. This means that a person without a degree, a license, or credentials of any type could legally practice psychotherapy as long as he or she does not call it psychotherapy.

We know of no third-party payor (insurance company, managed care organization, Medicare, etc.) who will pay for services provided by someone who is not licensed or registered in his or her state of practice. To learn whether your state has a licensure or registration act and what it may require, check with your state’s department of professional regulation. Most of these departments have a website that you can easily find with a search engine such as Google (www.google.com) or Yahoo (www.yahoo.com).

WHERE DO PSYCHOLOGISTS WORK?

The American Psychological Association (APA) conducts an annual survey of its members to learn about salaries and sources of income. The work settings of the 9,116 respondents in 2001 were as follows:

• 65 percent were employed in independent practices

• 46 percent in individual private practices

• 19 percent in group private practices

• 14 percent in hospitals and clinics

• 3 percent in schools

• 2 percent in other settings

Source: Darnell Singleton, Antoinette Tate, and Garrett Randall, Salaries in Psychology 2001: Report of the 2001 APA Salary Survey. APA Research Office, January 2003.

Many therapists look forward to the challenge of handling the many aspects of building a private practice. Others find the responsibility overwhelming, especially when they are just starting out. There are many ways to join forces with other therapists and enjoy the freedom of working on your own. Let’s take a look at a few of the most common types.

GROUP PRACTICES WITHOUT WALLS (GPWWS): ONE-STOP CONTRACTING

Group practices without walls are the most common type of practice group today. Several or more practices, from solo providers to larger practices of 10 to 15 members, form a group. The individuals who work in most GPWWs maintain practice independence but offer a combined size that is appealing to contracting payors. Financial arrangements vary from group to group.

Some GPWW leaders decide to incorporate. They may consolidate support staff and standardize software, forms, and procedures. They operate with one tax identification number, standardize staff hiring and credentialing standards, and function as a large practice. Primary practice owners may hold controlling positions, issue stock, set up a profit-sharing plan, and so on. Individual practices within the group may become less distinct from one another.

There is joint liability in any GPWW. As a GPWW is formed, members should seek the guidance of both an attorney and an accountant. Each person involved needs to have a clear understanding of his or her duties and responsibilities.

Benefits to the Members. As a member of a GPWW, you may gain contracts and referrals that you would not obtain if you were not part of the network. You may also find that working with such a group provides more resources and a more professional atmosphere than working alone. There may be more opportunities to share resources, obtain supervision, and avoid isolation.

Benefits to Payors. Payors prefer to have a single contract with one unit that manages 30 or more providers covering a two- to five-county region. They also prefer to have one contract to negotiate, one phone number to dial, and one contact person to reach if there is a problem. At the time of publication, it costs $100 to $150 per provider to manage contracts and credential providers, so it is less costly for a payor to work with a GPWW than with an individual provider.

NETWORK OR ANCHOR GROUPS

A network is typically owned by one individual. The network may cover more than one region and may offer more than one specialty. Similar to GPWWs, these practices appeal to payors due to ease of contracting and lower costs. Practices with such contracts are known as anchor groups. Anchor groups are similar to GPWWs in that they are made up of several independent providers or practices. The group forms a network to provide services under a general contract type (e.g., behavioral healthcare), but there are separate contracts for each provider, practice, or site. Network models tend to be located in more rural or less provider-saturated markets, whereas anchors tend to be located in more urban and suburban venues.

CAVEATS WHEN JOINING A GROUP PRACTICE

If you decide to join a group practice, use caution. In the American Association for Marriage and Family Therapy (AAMFT) newsletter Practice Strategies (March 1997 issue), the following guidelines were suggested:

• Ensure that fee payments are within ethical and legal guidelines. Stay away from fee splitting or any payment method that could be interpreted as paying for a referral.

• Check out the other therapists in the group. Your reputation will be affected by their reputations.

• Have separate interviews with each member of the group. Try to learn as much as you can about their relationships with one another.

• Ask to see the record-keeping system and evaluate the level of confidentiality that is maintained.

• Find out how often clients are billed and what percent become delinquent.

• Find out where the group’s referrals come from.

• Explore the group members’ ethics. Ask them questions to learn how they handle various ethical situations.

• Find out about managed care contracts and ask whether you will be added.

• Find out whether you would be able to refuse referrals from a managed care firm with whom the group is affiliated.

INDEPENDENT PRACTICE ASSOCIATIONS (IPAS)

An independent practice association (IPA) is a megagroup that has evolved from one or more large provider groups. IPAs tend to be well financed and are often backed with venture capital or large financial contributions to cover start-up costs (see Chapter 2). IPAs are different from the other practice models in that they generally offer:

• Many professionals on staff

• Professionals experien...

Table of contents

• Title Page
• Copyright Page
• Dedication
• Series Preface
• Introduction
• CHAPTER 1 - Discover Your Ideal Practice
• CHAPTER 2 - Finance Your Start-Up Practice
• CHAPTER 3 - Create a Business Plan
• CHAPTER 4 - Set Your Fees
• CHAPTER 5 - Set Up Shop and Measure Results
• CHAPTER 6 - Minimize Risk
• CHAPTER 7 - Manage Managed Care
• CHAPTER 8 - Market Your Practice
• CHAPTER 9 - Discover and Market Your Niche
• CHAPTER 10 - Generate Referrals
• CHAPTER 11 - Attract Media Attention
• CHAPTER 12 - Advertise Your Practice
• CHAPTER 13 - Presentations, Speeches, and Workshops
• CHAPTER 14 - Customer Service Skills for Therapists
• CHAPTER 15 - Self-Care for Therapists
• APPENDIX - Sample Forms
• Glossary
• References
• Index